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OPAT in the Teaching Hospital / Tertiary Centre
Dr Ann Chapman
OPAT in the teaching hospital/
tertiary centre
Ann Chapman
Consultant in Infectious
Diseases
Sheffield
Sheffield Teaching Hospitals NHS
Foundation Trust
• One of largest FTs in UK
• ‘Excellent’ rating:
• service quality
• financial management
• 250,000 IP episodes/year
• 15,000 staff
• 5 hospitals
• Specialist services
• Academic links
The Sheffield Infectious Diseases
Unit
Large regional unit
33 beds (17 negative pressure)
2500 emergency admissions/yr
Large outpatient service: TB,
HIV, hepatitis, travel
Inpatient consult service
across the trust
Large OPAT service
The Sheffield OPAT service
Multidisciplinary team:
4 nurse specialists
2 staff nurses
Support worker
Clerical officer
Junior doctor
Pharmacist
ID consultant
Microbiologist
The Sheffield OPAT service
Patient groups: cellulitis
Most now referred from GPs
Also from A+E, MAU and inpatient wards
Nurse-led model, moving towards PGD
Infusion centre
District nurses
Average OPAT duration 4/7
Wide range
Often complex
Main referrers: neurosurgery
ENT
orthopaedics
diabetes
cardiology
Self-administration
District nurse
Patient groups: other
Range of diagnoses (n=2030)
SSTI
CNS
BJI
UTI
CVS
Abd
Resp
Sepsis
Misc
Annual number of episodes
0
50
100
150
200
250
300
350
400
450
1 2 3 4 5 6 7
years
Annual bed days saved
0
1000
2000
3000
4000
5000
6000
7000
1 2 3 4 5 6 7
years
Outcomes
Clinically effective
Patient-centred
Safe
Cost-effective:
ID Unit costs National average costs ‘Hotel’
costs
41% 47% 61%
Chapman et al., JAC 2009
Future developments
Collaboration with community services to
increase home therapy
Ongoing promotion of OPAT to facilitate early
discharge (‘start smart then focus’)
Expansion of admission avoidance activity:
OPAT ‘in-reach’ within the trust
‘front door’ team
‘patient flow champions’
‘Right First Time Project’
Integrated service with primary care
OPAT ‘in-reach’
Integrated care for OPAT
Community team:
high capacity
Hospital team:
high complexity
Uncomplicated infections,
supervision by GP and
community nurses
Complex infections,
supervision by specialist
teams
Shared protocols, documentation, monitoring, etc
Strengths
•Opportunities for reduced LOS
and admission avoidance
•Infection specialist on site
•Clinical links
•Links with other OP IV therapies
•Infrastructure
•Escalation opportunities
Weaknesses
•Community links
•Internal marketing
•Limitations on some patient
groups depending on model
•Out of area patients
•Funding structures may be
detrimental to community
Opportunities
•Expansion of OPAT
•Amalgamation of OP IV
services within the tertiary centre
•Integrated care across sectors
Threats
•Financial pressures
•‘Any willing provider’
Conclusions
OPAT will continue to expand in the UK
Financial pressures
Care closer to home
‘Start smart then focus’
All models and service bases valid (n.b. GPRs)
Tertiary care model offers opportunity to focus
particularly on complex patients requiring long
courses of antibiotics
Important to maintain good community links